Sowing a Seed of Safety: Providing Culturally Safe Care in Acute Care Settings for People who use Drugs

This paper reviews the concept of cultural safety from the perspective of people who use illicit drugs and nurses in a hospital setting.   Background Illicit drug use is often highly stigmatized and people who use illicit drugs often report negative healthcare experiences contributing to inequities in health and access to healthcare. Registered nurses play a key role in the delivery of healthcare when people who use drugs are hospitalized but often face difficulties in the provision of care. We explored understandings and meanings of cultural safety in healthcare as an approach to mitigate stigma and to promote health equity.   Design and Methods Within an overall participatory approach to the research, we employed a qualitative ethnographic approach undertaking 275 hours of participant observation and conducting 34 open-ended interviews with 15 patients and 19 nurses on two acute care hospital units in 2012 and 2013. Result/Findings: Culturally safe care requires recognizing stereotypes and power imbalances; prioritizing trust and building relationships as important outcomes; giving patients space and time; and addressing conflicting organizational values and policies.   Conclusions Providing culturally safe care requires organizational culture shifts that recognize the importance of historical, societal, and political forces that influence the way in which illicit drug use and people who use illicit drugs are constructed in society.